Maybe you should wait a couple of months and retest to see if the 0.05 was a blip or the start of a trend. See what your doctor says! But there is evidence that very early salvage radiation has better outcomes than waiting for the PSA to rise to the conventional standard of BCR of 0.2.

Zzarth - I am in a very similar situation, and I also used Tewari. Like you, I had a frozen section positive (3+4) at the apex, which was treated for negative final margin. My dominant tumor was at the apex, 1.1 cm.I was undetectable till the two year mark, then went to .02, and then started testing at the local labcorp, .033 in May.

Like Wilderness said, not only he, but a number of others here had PSA that floated up, then back down. Let's hope that's the case for both of us. I'm sure Tewari told you not to be concerned untless and until it gets to .1

I had a couple of questions I wanted to email you but your email isn't active.1. Did you test at Tewari's office? If so, I'm curious, do you know what assay methodology was used? I know the hospital lab was bought by labcorp, so I thought they'd be doing the 3rd generation assay which goes to 3 decimals, rather than 2.

2. How did you find out that the 4 component was 20%? I was not given that info, Tewari said he didn't know. I went directly to the lab and got the more detailed path report but it didn't have that info.

Thanks all for the wise words of wisdom. I shouldn't have told my better half, she cried last night over it.

We just had a baby girl in Jan ... (my first) ... so there's that.

Anywho, thanks all, I get retested on Monday .. so I should know more later next week.

@pratoman -- hey man, long time no chat..

I didn't get tested at Tewari's office.. I live in Austin, so it would be hard to get there... in fact I haven't been in contact with him since the surgery.

After my operation, the team at Terwari's office sent me two documents, a Pathology Report and a Operative Report. In the Pathology report on page #2, under "SYNOPTIC REPORT FORMAT FOR PROSTATE TUMOR" .. it says % 4 component (3+4 & 4+3 only) 20%

What was the limit of detection (LoD) of your reported undetectable uPSAs on 1/17 and 4/17?

What was the method and equipment used? Do you know?

With this information one can try to find out the variance of the uPSA measurement, and how reliable it is (assuming that the samples are handled properly) by reading the information sheet of the manufacturer of the equipment and assay reagents.

I'm still checking with my doctor to get the info on the Jan and April tests.

For my last test I just had last week, the Roche PSA electrochemiluminescent immunoassay was used... that's all they told me so far.

I went in today and had another test... during the test, I was telling the phlebotomist about my situation, and she told me that for uPSA tests, it's important that they draw the blood without moving the needle around while drawing.

I told her, that the person who did it before, inserted the needed, and literally had to move it around a few times to find a good place to draw from... anyone hear of that one before?

Did you use the same lab?Family history of PCFather died on 2/16/2006 about 16 years after being diagnosed. Courageous man.My PSA 3.04Diagnosed at 54 October 20103/12 biopsies 5% 10% 15%Gleason 3+4open Surgery February 14th, 2011 Cleveland Clinic Dr. Eric KleinNegative margins/lymph nodes/seminal vessels/etc.ContinentNo ED issuesNon-detectable

I also got the results of my Decipher test that Tewari's team pulled last years .. I'm at 0.45 .. so right on the border of Low to Intermediate risk.

I don't really see Tewari for follow-ups... since hes across the country... If this result comes back at anything around 0.05 mark ... I think I need to head to a oncologist for a consult... right?

... my ED is still with me... and my leaking still is happening... starting to second guess my decision to go the surgical route ... probably would do brachy if I had to do it over again... .. oh well, shoulda coulda woulda.. hindsight is 20/20 .. I also would have loved to buy some Amazon stock 10 yrs ago, or some Bit Coin..

Tewari does a genomic test called Precise MD, but it's not as extensive as Decipher. I think you are doing all you can.As you know, I'm in a similar boat, right down to the positive margin at the apex on frozen section. For now, though, I seem to be stable, and my Decipher is .37. But who knows.

Just make contact with an RO you have confidence in, between now and your next PSA. Maybe if I were you, with the jump from <.01 to .05 and then a .07 in short order, retest in a month, maybe 2, rather than wait 3 or 4 months.Dx Age 64 Nov 2014, 4.3BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)downgraded to 3+3=6 by tDr Epstein, JHRALP with Dr Ash Tewari Jan 6, 2015Post surgical pathology – G7 (3+4), ECE, Margivns, LN, SV all negativePSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033Decipher test, low risk, .37 score

Scenario 1. Sometimes the PSA level never becomes undetectable after a prostatectomy. This situation, which is fortunately rare but among the most challenging to treat, means either that some cancer cells remained in the prostatic fossa (tissue left behind during surgery in the area once occupied by the prostate gland), or — more likely — that micrometastases had already spread beyond the prostate. A man in this situation may need additional therapy right away. The options offered may be radiation or hormone therapy, or both, or an investigational therapy.

Scenario 2. Sometimes the PSA falls to undetectable levels for several months following radical prostatectomy, and then begins to creep up. Typically, a man in this situation learns during one of his follow-up tests that he has experienced a biochemical recurrence. If the PSA level rises within the first year after surgery, it usually indicates metastatic disease. The treatment option most often offered is hormone therapy (either intermittent or continuous).

Scenario 3. The PSA does not begin to rise until a year or more after surgery. This is more likely to indicate localized disease, although it is possible that the disease has spread. Your treatment options depend on the PSA doubling time — how quickly PSA is increasing. If your PSA doubles in less than six months, and certainly less than three months, your doctor may recommend treating the area again, but this time with radiation or hormone therapy, in order to eradicate the disease.

Scenario 4. The PSA rises a year or more after surgery, but the doubling time is slow (a year or longer). This is probably the best scenario of all, as it indicates that the cancer may be localized and not aggressive. In this situation, you may opt for active surveillance — monitoring PSA and periodically having other tests, but not necessarily choosing an active intervention right away.

Is what they say under Scenario 2 true? ... PSA rising within first year = metastatic ???

The repeat ultra-sensitive PSA is elevated above that which would be expected in the post prostatectomy state. I suggest we confer with your urologist.

If you have any questions or concerns, please don't hesitate to call.

Sincerely,Dr. [snip]

Urologist?!?

I'm pretty pissed off... I was complaining about low pee volume for years ... and no friking Doctor thought about taking my PSA until I was 44 .. and the PSA value was already >15 !

including my primary care!!!

Here is what I wrote back

My response said...

Dr XXX Thank you for sending out the email to me on Friday about my PSA test going up.

I will immediately go talk to a Radiologist Oncologist, with a seconday priority to see my urologist (as you recommended).Keep in mind that urologists don't treat salvage RT patients.

With a rising u-PSA, eventhough it's under 0.2 ... it's probably best if we move quickly.. remember my PSA was over 15 when it was first tested ... Also, my urologist didn't treat me... also, I'm still a little bitter .. I should have had my PSA tested years ago when I reported urination problems.. My urologist prescribed me FloMax without even a hint to doing a precautionary PSA ... I would have paid out of pocket.See you soon

I'm so PISSED... I have ED, I pee on myself, and I'm having to deal with this cancer thing again .. it feels like it's all starting over again!!

My psa not undetectable until 19 months after surgery, then again 32 months after.

Thanks Wilderness --- this is a wake-up call for me, that I should have listened to back in November about Diet. Luckily I love Brussels sprouts

Should I be considering my PSA as detectable at my current 0.05 and 0.07 uPSA counts?

Also, any idea if that article I quoted about PSA being detectable within a year of RP as a indicator of metastatic cancer is based on 0.1 or 0.2 counts, or does it include modern uPSA detectability? ... I'm wondering if I'm really at a huge risk for Metastatic... anyone know?

First I want to say that I'm sorry that you and your wife are going through this. I've been following you since I joined HW. We started our PCa journey around the same time as you with our first ever PSA test being elevated as well.

I want to thank you for posting that article. I hadn't seen that one before.

From the article: "If the PSA level rises within the first year after surgery, it usually indicates metastatic disease."

All I can say is wow that's pretty sobering. Just confirms why many of us are living life in 3 month increments. Seems as though every test I say, ok now this will be an important one. Yep, they are all important, each one more important than the one last taken.